Mohammad Hassan Aboushaar, M.D.
Individual provider Active NPI Pediatrics Physician · Orange Park, FL
NPI 1194740993 · NPPES record last updated Nov 30, 2021
Key facts
- NPI
- 1194740993
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- ME65257 (FL)
- Practice address
- 1555 Kingsley Ave
Suite 601
Orange Park, FL 32073-4560 - Phone
- (904) 264-0264
- Fax
- (904) 278-2437
- NPI assigned
- Jul 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100324001138 | FL | Practitioner - Pediatric Medicine | 3971400227 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physicians Group Services PA | Current |
Accepting new patients | |
| Physicians Group Services PA | Pediatrics | Current |
Accepting new patients |
| Physicians Group Services PA | Pediatrics | Past | Accepting new patients |
Locations
1906 Southside Blvd
Jacksonville, FL 32216
Phone (904) 724-3083
7855 Argyle Forest Blvd
Ste 101
Jacksonville, FL 32244
1909 Beach Blvd
Ste 102
Jax Bch, FL 32250
Phone (904) 246-2752
1555 Kingsley Ave
Ste 601
Orange Park, FL 32073
Phone (904) 264-0264
705 Wells Rd
#300
Orange Park, FL 32073
Phone (904) 282-5474
Interoperability endpoints
- mohammad.aboushaar.1@25110.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME65257 | FL | Yes |
Addresses
Primary practice location
1555 Kingsley Ave
Suite 601
Orange Park, FL 32073-4560
Mailing address
705 Wells Rd Ste 300
Orange Park, FL 32073-2982
Phone (904) 282-6331
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 376161400 | Medicaid | FL |
Other providers in Orange Park, FL
- Judith Abbey
- Abcn Pain Management LLC
- Abdul Khalil Wallizada,MD
- Hanan Chadi Abdulwahed
- Ellen Rose Abellana
- Yairis Abreu Hernandez
- Kyle D Abshire
- Acacia Grove Assisted Living Facility LLC
- Cesar Doel Acevedo
- Ackerman Cancer Center
All providers in Orange Park, FL · Pediatrics Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.